Objective: To investigate the risk of petrosal vein (PV) sacrifice during endoscopic microvascular
decompression (E-MVD) in trigeminal neuralgia (TGN) and subsequent postoperative complications
and pain out comes
Methods: This is a retrospective study based on a 2013 date of adoption of the electronic
medical record and a standardized template for operative dictation with specific drop
down field for petrosal vein sacrifice coded as none, partial, or complete. A 5-year
interval review, from 2013 to 2018, yielded 201 consecutive patients undergoing MVD
by a single surgeon for trigeminal neuralgia. PV preservation or sacrifice, and vascular
compressive anatomy were noted. Postoperative complications attributable to venous
insufficiency as reported in the literature (cerebellar hemorrhage, midbrain and pontine
infarction, edema) were gleaned from patient charts. Preoperative and postoperative
pain outcomes were measured using the Basic Pain Inventory (BPI)-Facial (aka Penn
Facial Pain Scale), administered preoperatively and at 1-month follow-up, were analyzed
to determine potential association with PV preservation status.
Results: PV sacrifice was noted for 118/201 (59%) of patients, with 43/201 (21%) undergoing
partial sacrifice (denoted by cutting of only one or more branches of the petrosal
vein) versus 75/201 (37%) with complete sacrifice No cases of venous infarction, cerebellar
swelling, or fatal complications were noted in either cohort. Nonneurologic complications
(pulmonary embolus and NSTEMI) (2/201, 1%) were noted in 1.69% (2/118) of patients
with PV sacrifice and 0% (0/83) of patients with PV preservation (Fisher’s exact test,
p = 0.51). Neurologic deficits (facial palsy, conductive hearing loss, gait instability,
memory deficit) (4/201, 2%) occurred in equal proportions in PV preservation and sacrifice
groups (2.41 vs. 1.69%; Fisher’s exact test, p > 0.99). Furthermore, statistical analyses found no significant association between
PV preservation versus PV sacrifice in 6/7 metrics of subjective pain improvement
collected at 1-month follow-up. Comparative rates of headache at 1 month did not differ
significantly in PV preservation versus PV sacrifice (26.3 vs. 21.9%; Fisher’s exact
test, p > 0.05). Improvement in current pain at 1 month was found to be slightly higher in
the PV preservation group versus the PV sacrifice group (−5.5 vs. −1; Mann–Whitney
test, p = 0.036).
Conclusion: This negative study counters recent concerns speculation that PV sacrifice during
MVD leads to higher postoperative complication rates due to insufficient venous drainage.
While potential impact on short-term subjective improvement in pain cannot be fully
eliminated, PV sacrifice has no demonstrable relationship with complications following
surgery, reinforcing support for its continued use as a safe and justifiable surgical
technique when necessary for improved surgical visualization.
